Zhou Hua, Yang Min, Li Min, Cui Li
Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China.
Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China.
Int Urol Nephrol. 2017 Aug;49(8):1433-1437. doi: 10.1007/s11255-017-1604-0. Epub 2017 Apr 28.
Bone metabolism disorder is often associated with cardiovascular calcification in patients with chronic kidney disease (CKD). Sclerostin, a novel candidate protein, has been identified to be involved in the bone-vascular axis. The aims of the current investigation were to assess vessel sclerostin expression and its relationship with circulating sclerostin levels.
A cross-sectional observational study was conducted from January 2012 to December 2014. Thirty-two predialysis patients with CKD stage 5 who received arteriovenous fistula (AVF) operations were enrolled in this study. Radial arteries were collected and paraffin-embedded during the AVF operation, followed by immunohistochemical staining for sclerostin expression. In addition, serum sclerostin levels were measured by the enzyme-linked immunosorbent assay.
The prevalence of positive sclerostin staining in the radial arteries was 56.25%. Sclerostin expression was localized in the artery media layer. Serum sclerostin levels in patients with positive sclerostin expression were much higher than in those with negative expression (p = 0.018). Multivariate logistic regression analyses including potential confounders as age, gender, systolic blood pressure (BP), diastolic BP, serum sclerostin, corrected calcium (Ca), phosphate (P), Ca × P product, alkaline phosphatase, intact parathyroid hormone, and estimated glomerular filtration rate showed that only serum sclerostin levels were closely related to vessel sclerostin expression (p = 0.025). The area under the curve of serum sclerostin levels for predicting positive vessel sclerostin expression was 0.742 with 61.1% sensitivity and 85.7% specificity (p = 0.008). The cutoff point for vessel sclerostin expression of serum sclerostin was 1591.53 pg/mL.
Positive expression of sclerostin in the radial artery media layer was related to high serum sclerostin levels. Sclerostin may act as both a local and systemic regulator involved in vascular calcification.
骨代谢紊乱常与慢性肾脏病（CKD）患者的心血管钙化相关。硬化素是一种新发现的候选蛋白，已被证实参与骨 - 血管轴的调节。本研究旨在评估血管中硬化素的表达及其与循环中硬化素水平的关系。
本研究为横断面观察性研究，研究时间为2012年1月至2014年12月。纳入32例接受动静脉内瘘（AVF）手术的CKD 5期透析前患者。在AVF手术过程中采集桡动脉并进行石蜡包埋，随后进行硬化素表达的免疫组织化学染色。此外，采用酶联免疫吸附测定法检测血清硬化素水平。
桡动脉中硬化素染色阳性率为56.25%。硬化素表达定位于动脉中层。硬化素表达阳性患者的血清硬化素水平显著高于阴性患者（p = 0.018）。多因素逻辑回归分析纳入年龄、性别、收缩压（BP）、舒张压、血清硬化素、校正钙（Ca）、磷（P）、Ca×P乘积、碱性磷酸酶、完整甲状旁腺激素和估计肾小球滤过率等潜在混杂因素，结果显示只有血清硬化素水平与血管硬化素表达密切相关（p = 0.025）。血清硬化素水平预测血管硬化素表达阳性的曲线下面积为0.742，敏感性为61.1%，特异性为85.7%（p = 0.008）。血清硬化素预测血管硬化素表达的截断点为1591.53 pg/mL。
桡动脉中层硬化素的阳性表达与血清硬化素高水平相关。硬化素可能作为局部和全身调节因子参与血管钙化。
